HLA desensitization in kidney transplantation
Aida Turganbekova1,2, Saniya Abdrakhmanova2, Gulnara Kulkayeva3, Zhuldyz Zhanzakova2, Jamilya Saparbay3, Mels Assykbayev3, Gulnur Zhakhina3, Kuralay Zhangaziyeva2, Saniya Saussakova2,4.
1L.N.Gumilyov Eurasian National University, Nur-Sultan, Kazakhstan; 2Scientific and Production Center of Transfusiology, Nur-Sultan, Kazakhstan; 3National Research Oncology Center, Nur-Sultan, Kazakhstan; 4Astana Medical University, Nur-Sultan, Kazakhstan
Introduction: In the last decade, organ transplantation has been developing fast in Kazakhstan. 1892 transplants have been performed since 2012. Patients often need kidney (91.5%), heart (4.4%), liver (4%) transplantations. Nearly 100 kidney transplantations from living donors and 30 ones from deceased donors are performed annually. The most important factor hindering the long-term survival of recipients is HLA sensitization. The formation of specific antibodies to HLA may develop as a result of previous transplantation, blood transfusion or pregnancy. There are 3.5% highly sensitized patients among 3012 patients on the waiting list for kidney transplantation. This study aimed to review an effectiveness of desensitizing therapy during the preparation of patients for transplantation.
Methods: This study included 13 patients with end-stage chronic kidney disease (CKD). The participants underwent a general clinical examination, a specialized immunological study to determine the level of antibodies to leukocyte antigens (anti-HLA) before and after the desensitization stages. Microsoft Excel was used to perform statistical analyses. Qualitative variables were summarized in the form of absolute frequency and percentages.
Results: The proportion of male and female was 38.5% (5) and 61.5% (8), respectively. The average age of the participants was 44.8 years, ranging from 25 to 58 years. 30.8% (4) of patients had a decrease in the level of leukocyte antibodies after rituximab administration and three sessions of citrate plasmapheresis. In 23.1% (3) of patients, the level of sensitization remained same. An increase in the level of leukocyte antibodies was observed in 15.4% (2) of participants. 15.4% (2) of patients are currently at the second stage of desensitization. In 53.8% (7) of patients, a positive cross-match test is observed, which leads to the impossibility of kidney transplantation from living donor. A significant decrease in leukocyte antibodies was revealed in 53.8% (7) patients after repeated plasmapheresis sessions, despite the absence of differences in the level of antibodies after administration of rituximab and one plasmapheresis session. 46.2% (6) of the participants underwent only the first stage (rituximab) and one plasmapheresis session. 37.5% (3) of female had 5 or more pregnancies, which affects the increased immunological risk in CKD. 62.5% (5) of women had one pregnancy each and they had a decrease in the level of antibodies after rituximab and one plasmapheresis session. One patient has a significant decrease in the level of leukocyte antibodies after several sessions of plasmapheresis. 25% (2) undergo the first stage of desensitizing therapy.
Conclusion: According to preliminary data, the combination of plasmapheresis and rituximab was insufficient to achieve a negative cross-match test and kidney transplantation. In this regard, we recommend adding the introduction of human immunoglobulin to desensitizing therapy. This study is ongoing.
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